Medicare stipulates that a physician's referral is required for audiologic testing in order for payment to be made to audiologist. What does that ''referral'' need to say? Can the request be simply ''Hearing evaluation'' or ''For the evaluation of hearing loss''? Does the physician need to be more specific?
Answer
The Medicare Carriers Manual stipulates the following in Section 2070.3: services are ''paid for when a physician orders testing to obtain information as part of his/her diagnostic evaluation, or to determine the appropriate medical or surgical treatment of a hearing deficit or related medical problem''
Medicare expects that the physician be as clear as possible in the referral and indicate that the patient requires further evaluation consistent with the above statement from the Carriers Manual. Medicare does not pay for hearing evaluations when the physician knows that the best treatment for the hearing loss is a hearing aid. The physician should indicate if there is something remarkable about the hearing loss or a if there is a complaint of tinnitus, dizziness, vertigo or other associated symptom. For more information see https://www.asha.org/practice/reimbursement/medicare/aud_services.htm.
Steven C. White, PhD Director Health Care Economics and Advocacy American Speech-Language-Hearing Association 10801 Rockville Pike Rockville, MD 20852 phone 301-897-0126 fax 301-897-7356 email swhite@asha.org https://www.asha.org/
Steven C. White, PhD, CCC-A
Director of the Health Care Economics and Advocacy at the ASHA National Office.
Steven C. White, PhD, CCC-A, is the Director of the Health Care Economics and Advocacy at the ASHA National Office. White, an ASHA Fellow, is ex officio to the Health Care Economics Committee. His responsibilities include Medicare, private health insurance and Medicaid especially coding and outpatient reimbursement policies as they relate to these payers. White is the staff liaison to the American Medical Association Current Procedural Terminology Editorial Panel and the AMA Relative Value Update Committee. He has published and presented extensively on third party reimbursement. White is co-author with Janet McCarty of Health Plan Coding and Claims Guide (2005), Negotiating Health Care Contracts and Calculating Fees (2004), Appealing Health Plan Denials, and Getting Your Services Covered. White is also coauthor with Ingrida Lusis and Mark Kander of the Medicare Handbook for Audiologists (2005). White holds a PhD in audiology from Wayne State University and an MS in speech-language pathology and audiology from Ithaca College.
Related Courses
1https://www.audiologyonline.com/audiology-ceus/course/understanding-privilege-for-healthcare-professionals-36096Understanding Privilege, for Healthcare ProfessionalsSystems of privilege have created a wide division of inequality. This course will help hearing care professionals identify their privilege and determine how to make a difference in their places of employment.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comUnderstanding Privilege, for Healthcare ProfessionalsSystems of privilege have created a wide division of inequality. This course will help hearing care professionals identify their privilege and determine how to make a difference in their places of employment.36096OnlinePT60M
Systems of privilege have created a wide division of inequality. This course will help hearing care professionals identify their privilege and determine how to make a difference in their places of employment.
2https://www.audiologyonline.com/audiology-ceus/course/creating-leadership-in-audiology-through-37632Creating Leadership in Audiology Through a Mentoring CircleThere are so many components to quality patient care that it is challenging to “master” them all. What if you could come together with other professionals who possess knowledge or experience that could help you or your practice? There are a number of veteran audiologists as well as rising professionals who have wisdom, qualifications, narratives, and unique journeys to share. The purpose of this talk is to rethink the traditional mentor/mentee vertical relationship and explore collaboration in the form of circle…where all professionals, regardless of age or experience, learn from each other.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comCreating Leadership in Audiology Through a Mentoring CircleThere are so many components to quality patient care that it is challenging to “master” them all. What if you could come together with other professionals who possess knowledge or experience that could help you or your practice? There are a number of veteran audiologists as well as rising professionals who have wisdom, qualifications, narratives, and unique journeys to share. The purpose of this talk is to rethink the traditional mentor/mentee vertical relationship and explore collaboration in the form of circle…where all professionals, regardless of age or experience, learn from each other.37632OnlinePT60M
There are so many components to quality patient care that it is challenging to “master” them all. What if you could come together with other professionals who possess knowledge or experience that could help you or your practice? There are a number of veteran audiologists as well as rising professionals who have wisdom, qualifications, narratives, and unique journeys to share. The purpose of this talk is to rethink the traditional mentor/mentee vertical relationship and explore collaboration in the form of circle…where all professionals, regardless of age or experience, learn from each other.
3https://www.audiologyonline.com/audiology-ceus/course/using-patient-reported-outcome-measures-35841Using Patient-Reported Outcome Measures (PROMs) to Improve Patient-Clinician Communication and Enhance Treatment EfficacyDue to the recent increased focus on providing patient-centered healthcare, use of patient-reported outcome measures (PROMs) have become an essential component of assessing whether the services provided improved patients’ health and sense of well-being. This course will discuss the role of PROMs in healthcare and how using these measures in clinical practice can enhance treatment efficacy, improve patient-clinician communication, and assist clinicians in providing better person-centered care.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comUsing Patient-Reported Outcome Measures (PROMs) to Improve Patient-Clinician Communication and Enhance Treatment EfficacyDue to the recent increased focus on providing patient-centered healthcare, use of patient-reported outcome measures (PROMs) have become an essential component of assessing whether the services provided improved patients’ health and sense of well-being. This course will discuss the role of PROMs in healthcare and how using these measures in clinical practice can enhance treatment efficacy, improve patient-clinician communication, and assist clinicians in providing better person-centered care.35841OnlinePT60M
Due to the recent increased focus on providing patient-centered healthcare, use of patient-reported outcome measures (PROMs) have become an essential component of assessing whether the services provided improved patients’ health and sense of well-being. This course will discuss the role of PROMs in healthcare and how using these measures in clinical practice can enhance treatment efficacy, improve patient-clinician communication, and assist clinicians in providing better person-centered care.
4https://www.audiologyonline.com/audiology-ceus/course/salary-negotiations-32770Learn to Earn the Salary You Deserve: Negotiating Like a BossThe ability to negotiate your income displays immediate knowledge and confidence in your skillset and worth. In this course, we will examine a revenue and pay justification method to put into place as audiology business owners, employers, and employees.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comLearn to Earn the Salary You Deserve: Negotiating Like a BossThe ability to negotiate your income displays immediate knowledge and confidence in your skillset and worth. In this course, we will examine a revenue and pay justification method to put into place as audiology business owners, employers, and employees.32770OnlinePT60M
The ability to negotiate your income displays immediate knowledge and confidence in your skillset and worth. In this course, we will examine a revenue and pay justification method to put into place as audiology business owners, employers, and employees.
5https://www.audiologyonline.com/audiology-ceus/course/core-topics-for-audiology-assistants-37123Core Topics for Audiology AssistantsThis course includes one hour of content on each of the following topics: 1) ethical concepts and decision-making; 2) universal safety precautions, including the Occupational Safety & Health Administration's (OSHA) bloodborne pathogens standard, and 3) patient confidentiality and the Health Insurance Portability & Accountability Act (HIPAA).auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comCore Topics for Audiology AssistantsThis course includes one hour of content on each of the following topics: 1) ethical concepts and decision-making; 2) universal safety precautions, including the Occupational Safety & Health Administration's (OSHA) bloodborne pathogens standard, and 3) patient confidentiality and the Health Insurance Portability & Accountability Act (HIPAA).37123OnlinePT180M
This course includes one hour of content on each of the following topics: 1) ethical concepts and decision-making; 2) universal safety precautions, including the Occupational Safety & Health Administration's (OSHA) bloodborne pathogens standard, and 3) patient confidentiality and the Health Insurance Portability & Accountability Act (HIPAA).
